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Interview with Dr. Georg Wieselthaler: Lifesaving Options for Congestive Heart Failure

Audio Interview

Hear a Patient Power interview with Dr. Georg Wieselthaler, director of the UCSF Heart Transplant Program, and his patient Chris Wade, who underwent a heart transplant in April 2012 at age 46. Wieselthaler and Wade discuss the devices that can sustain a failing heart until a donor heart becomes available, and how a heart transplant saved Wade's life.

Interview Transcript

Andrew Schorr:

One of the most serious heart health issues is congestive heart failure, but there are new devices, coupled with heart transplants, that are helping give people a higher quality of life and the chance to live a long life. We're going to hear all about it next on Patient Power.

Andrew Schorr:

Hello and welcome to Patient Power sponsored by UCSF Medical Center. I'm Andrew Schorr.

Well, it can happen in a number of ways, but unfortunately there are literally millions of people in the U.S., over 5 million, who develop congestive heart failure. Their heart just cannot pump efficiently. They can develop fluid around their heart, can't walk up a flight of stairs, can't really lead a high quality of life. What can be done about it? Are there devices that can help their own heart pump? Where does heart transplant come in? And can the devices help a patient whose heart has been failing, maybe where they're even near death, to have more time and quality of life and get healthier if and when a donor heart can become available?

Well, let's start with the story of someone who has lived that experience. That's 46 year old Chris Wade. Chris used to have his own bakery in Oakland in the East Bay, and he faced all this. Chris, let's go back to where all this started, where you were in 2003, just really tired, right? You couldn't go up a flight of stairs, could you?

Chris Wade:

Yeah, I wasn't able to go up a flight of stairs, wasn't able to lay down flat and wasn't able to breathe.

Andrew Schorr:

Oh my goodness. So you finally go to the hospital, and my understanding is it turns out it was pneumonia and a virus that had eventually spread to your heart, and you had fluid around your heart. So if you were going to say on a scale of one to 10 — 10 being the most amount of fluid — what did they tell you it was?

Chris Wade:

A 10.

Andrew Schorr:

Oh my goodness. So you were a sick guy, immediately in the hospital. They get the fluid out of there, and you end up on medicines. Did the medicines work for a while?

Chris Wade:

I started to go on diuretics, which got all the extra water out of me, and I was able to live a little bit of a better life, to breathe and continue on with my daily activities, but just not at 100 percent.

Andrew Schorr:

Then, there was another shoe that dropped, right? Arrhythmia. What was happening to the rhythm of your heart?

Chris Wade:

I was having arrhythmia, irregular heartbeats, where it would fire maybe eight or nine beats in a row, maybe sometimes 15, so what happened was it would cause me to have a faint feeling inside of me and took all my energy away, and eventually I would be implanted with a defibrillator.

Andrew Schorr:

Oh my. And after a while that defibrillator was shocking you sometimes, wasn't it?

Chris Wade:

I had a few shocks here and there to shock my heart back into the rhythm it was supposed to be in.

Andrew Schorr:

Now, this is going on over a few years, six years or so, and I know with heart failure they measure your ejection fraction to calculate how well your heart is pumping. As it got to its low point what was your ejection fraction?

Chris Wade:

Seven is where it got down to.

Andrew Schorr:

Oh, my goodness. We're talking about 7 percent.

Chris Wade:

Seven percent. Yes.

Andrew Schorr:

Oh my. So you see your cardiologist and she gives you the bad news that you are in an end stage, right?

Chris Wade:

Right. That was in June of 2010.

Andrew Schorr:

So a decline over several years. They put you in an ambulance with a critical care nurse and bring you to UCSF Medical Center. You're in bed there and the doctor walks in. What does she tell you?

Chris Wade:

Dr. (Teresa) De Marco said that I would need to get a new heart.

Andrew Schorr:

And if you didn't?

Chris Wade:

Then, there were other options, but besides that, there was no hope.

Andrew Schorr:

Now, you're a man with four kids, three daughters now in college, a son in high school. You had a lot on your mind with this happening to you.

Chris Wade:

Absolutely. Absolutely.

Andrew Schorr:

But then they talk about one of the options, a left ventricular assist device (LVAD), a device to allow your heart to gain a little strength for you to get some strength back while you're waiting for a transplant. They explain to you that after a while you'd be in training, for you and your mother Clara as caregiver, to go home, right? That must have sounded like a reprieve, if you will.

Chris Wade:

It was almost just a relief to know that there was something out there that could actually bring me to transplant one day hopefully and to give me the quality of life back that I was having, you know, a little bit more of a quality of life than when I was on the medications alone.

Andrew Schorr:

So, Chris, within just a few days of being in that bed at UCSF, you had this LVAD implanted with the portable pump that you'd carry around. How did you feel afterwards?

Chris Wade

After I got over the surgery, after about a week or so, I started to feel a lot better, 100 percent better, actually.

I was able to breathe. I was able to walk. It gave me the hope and it gave me the confidence to be able to every day feel better and better and better and know that this was going to be the answer for me, hopefully making it one day to transplant.

Andrew Schorr:

And so you did have a decent quality of life. I mean, you had your son, I understand you were walking three miles a day with this portable pump. You were playing basketball with your son, Adam, pitching batting practice. So, you were living.

Chris Wade:

Absolutely. It impacted my quality of life. It gave me the gift of time, time to share with my son, my kids, and most of all being able to watch my four children grow and to actually be a little more active in their lives, as far as being able to do activities with them and be a father.

Andrew Schorr:

What a blessing. Now, one more key part of the story is the phone rings, 7 p.m., April 2012, and they say, "Chris, come over to UCSF. We have a donor heart for you." Quite a big day for you.

Chris Wade

Very emotional at first. Finally, when I got myself together and started over, I can't really even explain in words how it felt.

Andrew Schorr:

So, you had the transplant the next morning. We're going to meet your transplant surgeon in just a second. But here we are months later. The defibrillator came out. The LVAD came out. The transplant went in. How do you feel today?

Chris Wade:

I feel great. I got used to the medications now, and I'm back to where I was when I was 20 years old.

I walk a mile and a half a day. I am able to be a father again and to do everything I was before I came down with the cardiomyopathy, and it's just a 100 percent turnaround. It's amazing.

Andrew Schorr:

Do you feel you're living the miracle of modern medicine?

Chris Wade:

Absolutely.

Andrew Schorr:

Well, we're going to hear more from you in a second, but let's meet the man who helped with your heart transplant, really led the team, Dr. Georg Wieselthaler. Dr. Wieselthaler is the director and surgical chief for the Heart Transplant and Mechanical Circulatory Support Program at the UCSF Heart and Vascular Center. When we talk about mechanical circulatory support we're talking about that LVAD pump, right, doctor? And these have been perfected to a great degree. I know research goes on, but these have been miracle devices, haven't they?

Dr. Georg Wieselthaler:

Yes, they give us the opportunity nowadays to salvage patients who are in urgent need for support of their failing heart at the time we do not have an organ available for the patient. It gives us the opportunity to bridge the time period to the necessary transplantation.

Andrew Schorr:

And in Chris's case, he was near death. There was no heart for him at the time, and we have a shortage of donor organs anyway. He wouldn't have been able to survive without a device like this.

Dr. Georg Wieselthaler:

That is absolutely correct. At the time Chris Wade received his pump, he was in an urgent need of support of his circulatory system due to the fact that he was in what we call terminal, end stage heart failure. That means there is no reversal at this point and the patient is more or less terminally ill.

Andrew Schorr:

The second part of it is that not only did he get a pump, but he got a pump that was portable that he and his mom, Clara, as caregiver, were educated on so that he can look forward to playing basketball with his kid or pitching batting practice. People can have a pretty good quality of life while they're on that list hoping, hoping for a transplanted heart. That's quite something.

Dr. Georg Wieselthaler:

Well, actually we are happy that we were able to make developments over the last two to three decades with these mechanical circulatory support systems. About some 30 to 40 years ago when they started to develop these systems, people were bedridden. They were not allowed to get out of the bed. They were not allowed to leave the hospital.

Nowadays with the devices we have at hand, patients can nearly live a normal life. They have really few restrictions in a way that they cannot go for a swim at this time and have restrictions in a way that they have to reload the batteries that run these systems.

But otherwise, they are completely back to normal. They can nearly go back to a normal life, can go back to work, can live a normal social life with their families, and with their caregivers. And I think that's a big advancement in this field.

Andrew Schorr:

So just to be clear, and you're a heart surgeon, it's a surgery to implant the pump, implant the device. There's part of it that's portable that they take with them, so that's surgery No. 1.

Dr. Georg Wieselthaler:

Right.

Andrew Schorr:

And then, when there is a heart available, and hopefully there will be a match, part of the surgery is first take out the ventricular assist device, or the mechanical device, and then you're implanting the heart. So it's a two step process, right?

Dr. Georg Wieselthaler:

That is absolutely correct, although the two steps are combined with each other.

You cannot take out the pump first and leave the heart in and then take the heart out. You just do it in a combined procedure. This is quite normal.

I think it's important to say that the pump is placed inside the body so you don't see it from the outside. There is a tiny cable that leaves the body in the upper abdominal region and it's connected to the control unit, which is the size of a little bag connected to the batteries. So the pump sits inside the body. You cannot see it, you cannot hear it, and it's just the control unit, the tiny and small control unit that sits outside the body that actually runs the pump.

Andrew Schorr:

Chris, so you got used to all that. I mean, you were able to just deal with that in your daily life.

Chris Wade :

Oh, yeah. It was easy to get used to it. It became second nature

Andrew Schorr:

So, doctor, let me ask you about this. We have this mechanical device that fits into people's chest, and for Chris, so he could go about being a father and live his life while he's waiting. Then, there's a question of transplant. Now, that's been around for years. We've come a long way there, too, as far as the life expectancy and the quality of life someone like Chris could have post-transplant. Tell us about where we are now.

Dr. Georg Wieselthaler:

Well, patients who undergo cardiac transplantation nowadays have an extraordinary good life expectancy. We talk about the range of 10, 15, 20, 25 years. These patients can definitely have excellent quality of life during this life span. There are a few restrictions. They need to take their medicine on a regular basis and this medicine, more or less, they have to take it lifelong because it's the medicine that prevents patients from having a rejection of the transplanted organ.

But nevertheless besides that, they have excellent quality of life. And due to the fact that there are new methods in development to produce some kind of tolerance, as we would call it, from the human body to the transplanted organ, there is a good chance that maybe in five or 10 years, we can completely abolish all the medications. This would mean that all the side effects any medication can have can also be diminished.

Andrew Schorr:

Doctor, so the listeners to our program may be people who are where Chris was, or a family member, lying in bed, who is told they have end stage disease. Hopefully there will be a transplant but maybe these pumps can help, and people are learning about them. Would you say that there's a great deal of hope for these patients now with the technology and of course the skill that your team has as well?

Dr. Georg Wieselthaler:

Absolutely. I think we have developed methods and also have the kind of technology at hand that definitely can salvage patients with this end stage disease. But I think it's more important, not only to go for prevention of these diseases, but when you come close to the final stage, that you are not able to walk anymore, you have to be bedridden although you cannot lie flat due to the congestion, I think you have to see your doctor. You have to see a specialist that can transfer you to a specialized center, where they have the kind of technologies like this at hand.

Andrew Schorr:

And, Chris, I bet you just thank your lucky stars every day that you got to a center, in this case UCSF. They saved your life, didn't they?

Chris Wade:

Oh, absolutely. It's a miracle.

Andrew Schorr:

What would you say then to someone listening, who is depressed and thinks life may be over, whether a younger man as you've been or an older person. What hope would you give them?

Chris Wade:

I would tell them that if they are given the opportunity to get an LVAD, it would give you the quality of life that you could never imagine, back to where you were before you had congestive heart failure. I think that without my LVAD I would not be at transplant today, and I would say that you would be able to do things beyond your imagination. It's just a miracle.

Andrew Schorr:

Doctor, it must make you feel great, first of all to have Chris on this program with us and to hear how positive he is.

Dr. Georg Wieselthaler:

We are always grateful to have patients like Chris because these patients really deserve it. They have gone through such a bad period of their life. They had a lot of restrictions also on different levels, personal level, professional level. I think these patients really do fine afterwards, and they definitely deserve it.

It's no matter of age. It's not only that younger patients deserve it. I think if we are able to help older patients, and this is to me over the age of 70, 75, even 80. If a patient is in good shape and it is only the failing heart, I think we can fix that, and we can give them back good quality of life.

Andrew Schorr:

Dr. Georg Wieselthaler, thank you so much for all you do with the cardiac transplantation team and also the Mechanical Circulatory Support Program at UCSF. Thank you for all you do, doctor, and your continued work on the improvement of these devices and the surgical techniques so people can live a long, high quality of life. Thank you, sir.

Dr. Georg Wieselthaler:

You're welcome.

Andrew Schorr:

And, Chris, all we can say to you is I hope you dance at weddings of your daughters and your son and you just have a full life and keep baking. I'll have to connect with you and get one of those delicious things you bake.

Chris Wade:

Thank you very much.

Andrew Schorr:

Thank you very much.

Well, this is what we do on Patient Power — connect you with inspiring people like Chris Wade and the devoted doctors who have helped them. Here, technology and skill have come together and, let's face it, an organ donor to have Chris be with us and leading a full life. Thank you for joining us. I'm Andrew Schorr. Remember, knowledge can be the best medicine of all.

Recorded June 2012

 

Reviewed by health care specialists at UCSF Medical Center.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.